SINGLE FORM
27/11/2007
EUROPEAN COMMISSION
DIRECTORATE-GENERAL FOR HUMANITARIAN AID - ECHO
SINGLE FORM FOR HUMANITARIAN AID ACTIONS1
1. GENERAL INFORMATION
1.1
Name of Humanitarian Organisation/Country of registration:
1.2
Title of the Action:
1.3
Area of intervention (country, region, localities):
1.4
Start date of the Action:
If the Action has already started explain the reason that justifies this situation (urgent Action
or other reason):
1.5
Duration of the Action in months:
1.6
Start date for eligibility of expenditure:
Please explain if this date differs from submission initial proposal (see 1.10)
1.7
Requested funding modalities for this agreement
100% financing

Co-financing

Multi-donor (for International Organisations)

In case of 100% financing: justify the request
1.8
Urgent action Yes 
No 
If yes: ECHO Primary emergency decision 
ECHO Emergency decision

Other ECHO decision

Please justify:
Control mechanism to be applied: A 
P
1.9
1.10 Proposal and reports
Initial proposal
Revised proposal N°...
ECHO reference A/…
Intermediate report
Final report




date:
date:
date:
date:
date
dd-mm-yy
dd-mm-yy
dd-mm-yy
dd-mm-yy
dd-mm-yy
1.11 [INT]
List the supplementary agreements and exchange of letters after signature of
the Agreement up to intermediate report stage
1.12 [FIN]
List the supplementary agreements and exchange of letters after submission
of the Intermediate report up to final report stage
1At
proposal stage fill the numbered paragraphs, except those which start with [INT] (to be filled in at
intermediate report stage) or with [FIN] (to be filled in at final report stage). At intermediate and final report
stage, modify only key data in the numbered paragraphs (using strikethrough).
[Proposal][Agreement ECHO/…] – version [Date]
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2. NEEDS ASSESSMENT
2.1
Date(s) of assessment; methodology and sources of information used;
organisation/person(s) responsible for the assessment
2.2
Problem statement and stakeholder analysis
2.3
Summarise findings of the assessment (include full report in annex, if relevant) and
link these to the Action
2.4
[INT]
If changes in needs assessment at intermediate report stage, please explain
2.5
[FIN]
If changes in needs assessment after intermediate report, please explain
3. HUMANITARIAN ORGANISATION IN THE AREA OF INTERVENTION
3.1
Humanitarian Organisation's presence in the area of intervention: brief overview of
strategy and current or recent activities in the country
3.2
Actions currently on-going and funding requests submitted to other donors
(including other EC services) in the same area of intervention - indicate how overlap
and double funding would be avoided
3.3
[FIN]
List other Actions carried out by the Humanitarian Organisation or its
Implementing Partners in the same period in that area of intervention and how risks
for double funding were avoided
4. OPERATIONAL FRAMEWORK
4.1
Exact location of the Action (include map of project location)
4.2
Beneficiaries
4.2.1
Total number of direct beneficiaries:
4.2.2
Status of the direct beneficiaries (multiple options possible)
 IDPs
 Refugees
Returnees
 local population
 Others (e.g. for Grant Facility, thematic funding, etc.)
4.2.3
Specificities of direct beneficiaries (please elaborate, refer to groups as appropriate,
e.g. unaccompanied minors, disabled, children, ex-combatants…)
4.2.4
Direct beneficiary identification mechanisms and criteria
4.2.5
Describe to what extent and how the direct beneficiaries were involved in the
design of the Action
4.2.6
Other potential beneficiaries (indirect, "catchment", etc.)
4.2.7
Direct beneficiaries per sector:
Sector
Number of beneficiaries
[Proposal][Agreement ECHO/…] – version [Date]
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4.2.8
[INT] In case of changes, please explain
4.2.9
[FIN] In case of changes, please explain
4.2.10 [FIN] Estimate per type of beneficiaries
female:
… %,
male:
…%
infants (< 5y): … %,
children (< 18 y): … %,
[Proposal][Agreement ECHO/…] – version [Date]
(total female + male= 100%)
elderly: … %
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4.3
4.3.1
Objectives, Results and Activities
Operational Overview of the Action: Log-frame2 (max. 3 pages)
Title of the
Action
Principal
Objective
Intervention Logic
Objectively Verifiable
Indicators
Sources of Verification
Risks and Assumptions
Specific
Objective
Results
Activities
Pre-conditions
2
This table will be annex I of the signed Agreement. It has to give a comprehensive overview of the different elements of the Action. It will only contain concise information on
results and activities. Any changes made to the log-frame at intermediate report or final report stage will be done using strikethroughs.
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4.3.2
More detailed information per result3
4.3.2.1 Result 1: …
4.3.2.1.1 At proposal stage
- Total amount: … EUR
- Sector: ...
Related sub-sector: …
- Beneficiaries (status + number): …
- Indicators for this result:
- Activities related to the result
- Means4 and related costs
4.3.2.1.2 Intermediate report
- Total amount: …….…... EUR
- Update5 on indicators
- Update5 on beneficiaries (status + number)
- Update5 on activities
- Update5 on means and related costs
4.3.2.1.3 Final report
- Total amount: …….…... EUR
- Indicators for achieved result
- Final state on beneficiaries (status + number)
- Activities accomplished
- Finally committed means and related costs
4.3.2.2 Result x: …
4.3.2.2.1 At proposal stage
- Total amount: … EUR
- Sector: ...
Related sub-sector: …
3
Per result identified in the log-frame, more detailed information necessary for a good understanding of the
proposal/ report will be completed here. A specific sub-section per result at proposal, intermediate report
and final report stage has been foreseen (don't update information from a previous stage in this section,
comment the change in the appropriate sub-section of the result). See also the guidelines for more
information (e.g. for the list of sectors and related sub-sectors).
Also the main foreseen procurement procedures will have been identified (as well as in section 4.4 – work
plan).
4
The main means and costs (the sum of the indicated costs has thus not to be equal to the total amount for
that result) have to be identified to ease understanding how the results will be reached and the activities
implemented.
5
Update and explanation to be provided on progress as well as on changes made to the proposal.
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- Beneficiaries (status + number): …
- Indicators for this result:
- Activities related to the result
- Means4 and related costs
4.3.2.2.2 Intermediate report
- Total amount: …….…... EUR
- Update5 on indicators
- Update5 on beneficiaries (status + number)
- Update5 on activities
- Update5 on means and related costs
4.3.2.2.3 Final report
- Total amount: …….…... EUR
- Indicators for achieved result
- Final state on beneficiaries (status + number)
- Activities accomplished
- Finally committed means and related costs
4.3.2.3 Result x: …
4.3.2.3.1 At proposal stage
- Total amount: … EUR
- Sector: ...
Related sub-sector: …
- Beneficiaries (status + number): …
- Indicators for this result:
- Activities related to the result
- Means4 and related costs
4.3.2.3.2 Intermediate report
- Total amount: …….…... EUR
- Update5 on indicators
- Update5 on beneficiaries (status + number)
- Update5 on activities
- Update5 on means and related costs
4.3.2.3.3 Final report
- Total amount: …….…... EUR
- Indicators for achieved result
- Final state on beneficiaries (status + number)
- Activities accomplished
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- Finally committed means and related costs
4.3.2.4 Other costs6
Initial
amount
Intermediate
amount
Final
Committed
Total other costs
4.4
4.4.1
4.5
Work plan (e.g. annex Gantt chart)
[INT] Revised work plan, if changed after proposal
Monitoring, evaluation, audit and other studies
4.5.1
Monitoring of activities (explain how, by whom)
4.5.2
Tick the box if one of the following studies will be undertaken:
 an external evaluation during the Action
 an external evaluation after the Action
 an external audit during the Action
 an external audit after the Action
 an internal evaluation or internal audit related to the Action
4.5.3
Other studies:  please elaborate:
(please remember that for external evaluations, audits and studies financed by the
Commission the Terms of Reference have to be agreed by DG ECHO before launching the
selection procedure)
5. CROSS-CUTTING ISSUES
5.1
Describe the expected level of sustainability and/or connectedness7
5.2
Continuum strategy (Linking Relief, Rehabilitation and Development)
5.3
Mainstreaming (e.g. Disaster Risk Reduction, Children, Human rights, Gender,
Environmental impacts, others to be specified)
5.4
[INT]
In case of changes or problems to be addressed, please explain
5.5
[FIN]
In case of changes or problems to be addressed, please explain
6
The last table groups the costs that have not been dedicated to one specific result (support costs,
feasibility studies, audits etc. as explained in the guidelines). The total of the total amounts mentioned per
result and in this table will correspond to the subtotal direct eligible costs in the table section 11.
7
Sustainability and connectedness are similar concepts used to ensure that activities are carried out in a
context that takes longer-term and interconnected problems into account.
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6. FIELD COORDINATION
6.1
Field co-ordination (indicate the Humanitarian Organisation's participation in
coordination mechanisms with other relevant stakeholders, e.g. clusters, NGOs, UN
agencies, others to be specified as well as the links with the Consolidated Appeal
Process, when relevant)
6.2
National and local authorities (relations established, authorisations, coordination)
6.3
Co-ordination with DG ECHO (indicate the Humanitarian Organisation's contacts with
DG ECHO and its technical assistants in the field)
6.4
[INT]
In case of changes or co-ordination problems, please explain
6.5
[FIN]
In case of changes or co-ordination problems, please explain
7. IMPLEMENTING PARTNERS
7.1
Name and address of implementing partner(s)
7.2
Status of implementing partners (e.g. NGO, local authorities, etc.) and their role
7.3
Type of relationship with implementing partner(s) and the expected reporting by the
implementing partner
7.4
[INT]
In case of changes, please explain
7.5
[FIN]
In case of changes, please explain
8. SECURITY AND CONTINGENCY MEASURES
8.1
Contingency measures (Plan B/ mitigating actions to be taken if risks and
assumptions spelled out in the log-frame materialised)
8.2
Security considerations
8.2.1
Security situation in the field, describe briefly
8.2.2
Has a specific security protocol for this Action been established?
Yes 
No

Standard procedures

If yes please elaborate:
8.2.3
Are field staff and expatriates informed of and trained in these procedures?
Yes 
No

8.3
[INT]
In case of changes or problems to be addressed, please explain
8.4
[FIN]
In case of changes or problems to be addressed, please explain
9. COMMUNICATION, VISIBILITY AND INFORMATION ACTIVITIES
9.1
Planned communication activities (in field and/or in Europe)
9.2
Visibility on durable equipment, major supplies, and at project locations
9.3
Planned publication activities
9.4
[INT]
In case of changes, please explain
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9.5
[FIN]
Report on the relevant activities
10.HUMAN RESOURCES
10.1 Indicate global figures per function and status
Function
Status8
Number Number of
of staff
man/ month
in project
10.2 [INT]
In case of changes, please explain
10.3 [FIN]
In case of changes, please explain
8
Comments
Expat, local staff, staff of the implementing partner,…
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11.FINANCIAL OVERVIEW OF THE ACTION9
Eligible cost of Action10
Initial
Intermediate report
budget
Budget
Committed
Final
committed
Funding of Action
Personnel costs
Direct revenue from Action
Communication, visibility, information
Contribution by applicant
Equipment costs
Contribution by other donors
Sub-contracting costs
Contribution requested from ECHO
Consumables & goods costs
Initial
Final
state
% of total funding:
Other costs
Subtotal direct eligible costs
Indirect costs (max. 7%)
Total Costs
11.1 [FIN]
9
Total Funding
In case of other donors, please identify the donors and the amount provided
This table will constitute annex II of the signed Agreement.
10
The partner can use another representation of costs in line with the current practice in its organisation. These headings will become the chapters of the final financial
reporting. In case personnel costs and the costs on information, communication and visibility are not explicitly available in section 4.3.2, these have to be explicitly mentioned
in this table.
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12.ADMINISTRATIVE INFORMATION
12.1 FPA number (if applicable)
12.2 Name and title of legal representative signing the Agreement
12.3 Name, telephone, e-mail and title of the person(s) to be mentioned in Article 7 of the
Agreement
12.4 Name, telephone, fax and e-mail of the representative in the area of intervention
12.5 Bank account
Name of bank: […]
Address of branch: […]
Precise denomination of the account holder: […]
Full account number (including bank codes): […]
IBAN account code, (or BIC country code if the IBAN code does not apply): […]
13.[FIN] CONCLUSIONS AND HUMANITARIAN ORGANISATION'S
COMMENTS
[Proposal][Agreement ECHO/…] – version [Date]
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Annex A: Procurement table11
Description of the supplies, services or
works
Quantity
Amount
(EUR)
12
Procurement procedure
Derog
ation
Y/N
(Forecast)
Launch date
procedure13
(Forecast)
Contracting
date
11
This table is only mandatory for Agreements with an A-control mechanism. It regroups the main significant procurement procedures for this Action and will be updated
at proposal, intermediate report and final report stage. The Partner may attach a table with another lay-out (e.g. already used inside the project) provided that at least the
above mentioned information is available. These tables do not have to be provided for Agreements with a P-control mechanism.
12
Open international tender, open local tender, negotiated procedure, single quote, framework contract or use of a Humanitarian Procurement Centre (HPC).
13
The dates can also be expressed in number of weeks after the start of the Action.
[Proposal][Agreement ECHO/…] – version [Date]
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